2023 Queens Collegiate Family Information Form - Contacts, Address Verification & Student Release Form
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Email *
Student LAST Name(s) *
Student FIRST Name(s) *
Student Home Address (Please provide FULL address- example: 138-11 35th Avenue, Apt 2A, Flushing NY 11354) *
Student OSIS (ID) number (Enter 000 if you do not know this number)
Student Date Of Birth *
MM
/
DD
/
YYYY
Student Cell Phone Number *
Student's personal email address *
Student's grade in September 2023 *
Parent/Guardian #1 FIRST & LAST Name *
Parent/Guardian #1 FULL Home Address (Please provide FULL address- example: 138-11 35th Avenue, Apt 2A, Flushing NY 11354) *
Parent/Guardian #1 Cell Phone Number *
Parent/Guardian #1 Email Address *
Parent/Guardian #2 FIRST & LAST NAME
Parent/Guardian #2  FULL Home Address (Please provide FULL address- example: 138-11 35th Avenue, Apt 2A, Flushing NY 11354)
Parent/Guardian #2 Cell Phone Number
Parent/Guardian #2 Email Address
Does this child have any siblings in NYC schools?  If so, please list their name and school.  
Language(s) spoken at home (check all that apply) *
Required
Language(s) in which the parent/guardian reads and writes (check all that apply) *
Required
Media Consent: I hereby consent to my child participating in interviews, the use of quotes, and the taking of photographs, movies or video tapes of the Student named above by Queens Collegiate.  I also grant to the right to edit, use, and reuse said products for nonprofit purposes including use in print, on the internet, and all other forms of media. I also hereby release the New YorkCity Department of Education and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above. *
Other Contact #1 FIRST & LAST NAME (This may be a relative or adult sibling)
Relationship (For example Grandmother, Uncle, Sister, etc.)
Other Contact #1  Cell Phone Number
Other Contact #1 Email Address
Other Contact #2 First and Last Name (This may be a relative or adult sibling)
Relationship (For example Grandmother, Uncle, Sister, etc.)
Other Contact #2 Cell Phone Number
Other Contact #2 Email Address
Name of person who filled out this form
Please fill this required Lunch form for your NYCDOE Student.  https://www.myschoolapps.com/Home/PickDistrict  *
Required
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